Third week

Ethical Issues in NursingManagement

Prepared By, Dr. Mohammad Barahemah

Introduction:

As with any paradigm shift, a new way of viewing the world brings with it some of the enduring values of the previous worldview.

Ethical decision-making frameworks will remain constant, but the context for examining these moral issues or ethical dilemmas will become increasingly complex.

Prepared By, Dr. Mohammad Barahemah

What is ethics?

Ethics is the systematic study of what a person’s conduct and actions should be with regard to self, other human, and the environment.

It is the Justification of what is the right or and what is the wrong based on the human values.

Prepared By, Dr. Mohammad Barahemah

Applied ethics,

requires application of normative ethical theory to everyday problem.

The values and the norms of the nursing profession provide the foundation and filter from which ethical decision are made.

Prepared By, Dr. Mohammad Barahemah

Nurse are often placed in situations where expected to be agent for patients, physicians, and the organization simultaneously, all of which may have conflict needs and goals.

To make the appropriate ethical decision, the nurse must have the knowledge of ethical principles and framework.

Prepared By, Dr. Mohammad Barahemah

Bioethics Bioethics is defined as the study and

formulation of healthcare ethics.

Bioethics takes on relevant ethical problems experienced by health care providers in the provision of care to individuals and groups.

As technology advances increased, recognition and acknowledgment of rights and the needs of individuals and groups receiving this high tech care also increased.

Prepared By, Dr. Mohammad Barahemah

Advance Directive

Advanced Directives are documents that state in writing the pts wishes for healthcare interventions if they should become incapacitated.

Include Directive to Physician and Family or Surrogate

Most common. Allows pt to document wishes for tx or withdrawal, also commonly known as “Living Will”

Medical Power of Attorney Allows the pt to designate another person as their decision

maker Out of Hospital Do-Not-Resuscitate Order

Allows competent adults to refuse life sustaining procedures when out of the hospital setting. Can include not wanting to be taken to ER, let me sit here and die…

Declaration of Mental Health Treatment Allows a court to determine incapacity and allows the pt to

refuse electro convulsive therapy (ECT) and psychoactive drugs

Prepared By, Dr. Mohammad Barahemah

Euthanasia:

Definition – intentional termination of life (at the request of that person who wishes to die)

Active vs. Passive Generally illegal May be legal under certain circumstances Active – involves purposefully causing the persons

death (doc or nurse). Passive – involves hastening of death by altering some

form of support, taking a pt off a vent.

Prepared By, Dr. Mohammad Barahemah

Organizational process to assist inethical decision making:

Institutional Review Board (IRB)

Ethics Committee

Professional Code of ethics.

Prepared By, Dr. Mohammad Barahemah

Type of Ethical Issues:

Moral uncertainty: when the duties and obligation of health care providers or general ethical principle are unclear.

Example, Suppose that there is a new drug that will makes the HIV patients live longer but it has many adverse effects.

Prepared By, Dr. Mohammad Barahemah

Moral Distress:

Is the results of the individual knowing the right thing to do but the organization constraints make it difficult to take the right action.

Example, the patient case need at least two weeks of medical care but the hospital’s policy prevent the patient to stay for longer than one week.

Prepared By, Dr. Mohammad Barahemah

Moral outrage:

When the individual witness the immoral act of another but feels powerless to stop it.

Example, When the nurse being witness on medical error from another medical staff but couldn’t report that.

Prepared By, Dr. Mohammad Barahemah

Ethical Dilemma

The most difficult of all moral issues.

When two ( or more) clear moral principle apply but they support inconsistent course of actions.

Example, informing critical ill patient about his/her serious health condition.

Prepared By, Dr. Mohammad Barahemah

Ethical Framework for Decision Making

Teleological theory (consequentialist): consist of judging whether the consequence of an action are good or bad.

The nurse will make the decision based on what provide the greatest good for greatest number of people.

Example, Tuskegee experimentPrepared By, Dr. Mohammad Barahemah

Deontological Ethical theory

Judges whether the action is right or wrong regardless of the consequences.

Duty-based reasoning: a duty to do something or to refrain from doing something.

Example, the supervisor feels a duty to hire the most qualified person.

Prepared By, Dr. Mohammad Barahemah

Deontological Ethical theory

Right-based reasoning: Individuals have the basic inherent right that should not be interfered with.

Example, all job applicant have the right for fair consideration of their application.

Prepared By, Dr. Mohammad Barahemah

Intuitionist Framework:

Each case weighed on a case-by-case basis to determine relative goals, duties, and rights.

This weighting is determined based on the intuition.

May contain bias because it based on selfperception.

Prepared By, Dr. Mohammad Barahemah

Principles of Ethical reasoning:

Autonomy: Promotes self-determination and freedom of choice.

Beneficence: Actions are taken in effort to promote good.

Paternalism: One individual assumes the right to make decisions for another.

Justice: Seek fairness; treat “equal” equally and treat “unequal's” according to their difference.

Prepared By, Dr. Mohammad Barahemah

Principles of Ethical reasoning:

Utility: The good of many outweigh the wants or needs of the individual.

Veracity: Obligation to tell the truth.

Fidelity: Need to keep the promises.

Confidentiality: Keep privileged information private.

Prepared By, Dr. Mohammad Barahemah

Autonomy

Definition: “autos” = self, “nomos” = rule Individual rights

Privacy

Freedom of choice

Pt has the right to make decisions for themselves. May see this come up with consent for treatment issues, informed consent. Pt has right to know procedure, complications, other options, that they can opt to not have the procedure/treatment.

Prepared By, Dr. Mohammad Barahemah

Beneficence & Nonmaleficence

Duty to do good

goodness, kindness, charity

Includes non-maleficence

Duty: NOT TO CAUSE harm

Duty: PREVENT harm

Duty: REMOVE harm

More binding than beneficence

Because you’re going beyond just trying to do good to that pt, you’re trying to prevent harm

Prepared By, Dr. Mohammad Barahemah

Confidentiality

Keep privileged information private

Exceptions Protecting one person’s privacy harms another

or threatens social good (direct threat to another person)

Drug abuse in employees, elder and child abuse

HIPAA

Prepared By, Dr. Mohammad Barahemah

Fidelity

Duty to be faithful to one’s commitments

includes implicit and explicit promises

Make a promise, follow thru

Implicit – those promises that are implied, not verbally communicated

Like when pt comes into the hospital, they expect to be cared for

Explicit – those that we verbally communicate

Like if you tell them you’ll be back with pain meds, you’d better come back

Prepared By, Dr. Mohammad Barahemah

Justice

Seeks fairness

More specifically, distributive justicerefers to distribution of benefits and burdens.

Distributive Justice Concepts Equally disbursed

according to

Need

Effort

Societal contribution

Merit

Legal entitlementPrepared By, Dr. Mohammad Barahemah

Paternalism

When one individual assumes the right to make decisions for another

Limits freedom of choice

Think about parents making decisions for children

Ex. Withholding information from a pt. Like elderly dx with terminal cancer, and family asks to not tell them that it’s terminal so they will still be motivated to fight.

Prepared By, Dr. Mohammad Barahemah

Veracity

The obligation to tell the truth and not to lie or deceive others

Prepared By, Dr. Mohammad Barahemah

Short Video

Prepared By, Dr. Mohammad Barahemah

Nursing Code of Ethics

Is a set of principles, established by the profession, that nurse/ nurse manager can use for a guidance in ethical problem solving.

Example, ANA ( American nurse Association), Jordanian Nurse Code of Ethics.

Prepared By, Dr. Mohammad Barahemah

The Traditional Problem Solving Process

1. Identify the problem.

2. Gather the data.

3. Explore alternative solutions.

4. Evaluate the alternatives.

5. Select appropriate solutions.

6. Implement the solution.

7. Evaluate the results.

Prepared By, Dr. Mohammad Barahemah

Practice Question:

Miss N is a nurse in the cardiac unit for 65 years doctor who was admitted to her unit after sudden chest pain.

The Doctor was heavy smoker, and after he recovered, he started to ask the nurse to allow him to walk outside the unit.

Miss N suspect that the patient want to smoke.

Prepared By, Dr. Mohammad Barahemah

The Nursing Process:

Assessment

Diagnosis

Planning

Intervention

Evaluation

Prepared By, Dr. Mohammad Barahemah

Practice Question

As a chief nurse of the Surgical floor, it will be your responsibility to select the best nurse to be the in-charge nurse. However, one of your best friend is one of the candidate.

Prepared By, Dr. Mohammad Barahemah

The MORAL Decision Making Process

M: Massage the dilemma

O: Outline Options

R: Review Criteria and Resolve.

A: Affirm position and act

L: Look back

Prepared By, Dr. Mohammad Barahemah

Practice Question:

Mr. S is a 3 days fresh nurse working at the ICU unit in a particular hospital.

Mr. S is suppose to help another senior nurse during the orientation period.

The Senior nurse asked Mr. S to handle him 30meq KCL IV push to inject the brain death patient in their Unit.

Mr. S knows that 30 meq KCL will cause cardiac death.

Prepared By, Dr. Mohammad Barahemah

Integration Leadership Roles AndManagement Function in Ethics

As a leader you will be exposes to everyday ethical dilemma.

There is always uncertainty and ambiguity as a part of decision making.

Nurse leader should be expert in at using systematic approach to solve ethical issues.

Prepared By, Dr. Mohammad Barahemah